title: Holmium laser enucleation of the prostate--outcomes independent of prostate size?
abstract: OBJECTIVE
  Generally treatment decisions for benign prostatic hyperplasia are based on prostate size and surgeon experience. Prostates greater than 100 gm often require open surgery. However, less invasive options are available. Randomized, controlled trials have demonstrated that holmium laser enucleation of the prostate is a viable and effective treatment for benign prostatic hyperplasia. We examined the outcome of holmium laser enucleation of the prostate based on prostate size.
  
  
  METHODS
  We retrospectively reviewed the records of all patients in our institutional review board approved database who underwent holmium laser enucleation of the prostate from January 1999 to October 2006. Patients were divided into 3 cohorts based on preoperative transrectal ultrasound prostate measurements, including less than 75, 75 to 125 and more than 125 gm. Patients with prostate cancer were excluded from study. Demographic, laboratory, operative, preoperative and postoperative data were obtained.
  
  
  RESULTS
  As prostate size increased, so did prostate specific antigen, and the urinary retention and enucleation rates. Hospitalization, catheterization, preoperative and postoperative outcomes were similar among the groups. On linear regression the decrease in prostate specific antigen highly correlated with the amount of tissue removed (p <0.0001). The complication rate was similar among the treatment groups. All patients did equally well in terms of postoperative urinary function independent of prostate size.
  
  
  CONCLUSIONS
  Holmium laser enucleation of the prostate is a safe and effective minimally invasive treatment for benign prostatic hyperplasia. It improved patient prostate specific antigen, American Urological Association symptom score and maximum urinary flow rate independent of the amount of benign prostatic hyperplasia present. Our results demonstrate the advantage of holmium laser enucleation of the prostate to treat all prostates regardless of size with favorable and equivalent outcomes.
authors.affiliation: Department of Urology, Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.forename: Shelly E
authors.initials: SE
authors.lastname: Handa
authors.forename: Colin
authors.initials: C
authors.lastname: Terry
authors.forename: Larry C
authors.initials: LC
authors.lastname: Munch
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies